Military veteran's experience of mental health services
Research type
Research Study
Full title
Exploring how veterans with service-related traumatic brain injury, who are drinking at a hazardous or harmful level, experience mental health services
IRAS ID
255557
Contact name
Laura Goodwin
Contact email
Sponsor organisation
University of Liverpool
Duration of Study in the UK
1 years, 2 months, 14 days
Research summary
Summary Of Research
There are approximately 2.5 million UK armed forces veterans residing within Great Britain. The prevalence of mental health difficulties within UK Veterans is approximately 37%. Additionally, alcohol use has been found to be more common in UK Armed forces than the general population, and it is believed that 61% have an increased risk of alcohol-related harm. Furthermore, head injuries have been reported to be ‘signature wounds’ of recent wars, with high co-morbidity with mental health difficulties.
This study aims to explore how veterans with service-related head injury (traumatic brain injury [TBI]), who are involved in hazardous or harmful levels of drinking, experience mental health services. Additional sub-aims include the exploration of 1) their process of help-seeking, 2) what has been beneficial and what changes could improve the process and experience of using this service 3) the veterans’ attributions of their symptoms and how this may impact on their experiences of accessing mental health services.
This study will be completed with the Military Veterans Service, Pennine Care NHS. Therefore, any individuals who access this service, speak fluent English, have capacity to consent, self-report a mild TBI (head injury) and score 8+ on the alcohol use disorders identification test (AUDIT) are eligible to participate. Recruitment will continue until theoretical saturation is reached, however approximately 8-12 participants will be interviewed about their experiences of accessing support (their decision and journey to seeing help) and their understanding of their experiences and presentation. This will occur at a time and location suited to the participant (using locations routinely accessed by the service). The interviews will be recorded via secure iPad or Dictaphone, transcribed by the student researcher and a professional transcriber, and analysed via interpretive phenomenological analysis (IPA) by the student researcher.Summary Of Results
Face-to-face semi-structured interviews identified four main themes which reflected their journey to accessing services: ‘Denial to acceptance of needing support’, ‘Sense of self’, ‘Knowledge is power’ and ‘Relationship with services’. Each theme had between two and four sub-themes within them (see table 1 below). Themes were viewed as barriers and facilitators to accessing mental health services, which aligns with previous research exploring help-seeking with mental health experiences.
Many of the barriers to accessing services that were evident a decade ago were still present; therefore, ongoing programmes to facilitate engagement are required to continue to reduce barriers. The importance of both promoting access to services and engagement with services was highlighted. This research can be used by clinicians to facilitate an understanding of the journey veterans have experienced and themes which are important to them.
Unlike previous literature that stated veterans predominantly conceptualise their co-occurring experiences from a biological understanding, participants within this study focused on the psychological experiences more than their TBI. The current study also found that participants used clinical and diagnostic terminology, which is different to previous qualitative studies exploring expressions of emotional distress.
Things to take away:
This is the first study to provide an interpretative account of veterans’ experiences of accessing mental health services, with mental health difficulties, alcohol misuse and TBI. Veterans generally disclosed negative experiences of accessing both charities and NHS services, although there were variances in this. Veterans felt abandoned by the Armed Forces, yet, they had not adjusted to civilian life and therefore did not know where or how to get help. This highlights the need for more awareness and understanding of mental health within the Armed Forces, and transition support for veterans.
Themes related to veterans’ journey and barriers and facilitators related to accessing services and engagement with services. Consequently, promoting both access to services, which was the main aim of this study, and engagement with services is key. Earlier recognition of difficulties may cause earlier engagement with services, as veterans often had reliance upon their support network to help access support. Therefore, it is also important to increase family members’ awareness of available support. It is also important to include the support network in therapeutic interventions as the veteran exists within a relational and cultural context, which must be considered.
Veterans spoke about a lack of consistency and collaboration between services, which is contradictory to a key factor for service provision documented in strategy. Therefore, there is a mismatch between veterans who are going through their help-seeking journey and policy. Therefore, his highlighted that more work needs to be implemented to try and close this gap.
Clinicians could use the themes that developed to understand internal and external conflicts their clients may be experiencing throughout their journey to services. Factors identified in this study may be present throughout engagement. This study also provides an understanding of veterans with this multi-morbidity presentation (experiencing more than one difficulty: mental health, alcohol misuse and TBI), from their lived experiences and beliefs. This highlights the importance of ensuring clients’ needs are met regarding the physical set up of sessions, accounting for their concentration, fatigue and memory difficulties.REC name
North West - Greater Manchester East Research Ethics Committee
REC reference
19/NW/0166
Date of REC Opinion
28 Mar 2019
REC opinion
Favourable Opinion